ORTHOPAEDICS CASE PRESENTATION

NON UNION
Mentor : Prof Sharath, BMCRI
Presentation by : Priya Ashok Menon, 9th Term, Ramaiah Medical College.
PATIENT PARTICULARS
➤ Age : 74yrs
➤ Sex : Female
➤ Residence : Yeshwantpur Bangalore
➤ DOA : 13.10.2021
➤ DOE: 15.10.2021
CHIEF COMPLAINTS
➤ Inability to walk since 6 months
➤ Discharge from surgical wound on left leg since 4 weeks
 HISTORY OF PRESENTING ILLNESS
➤ Patient was apparently alright 6 months ago, when she had a fall at night while
walking out from the bathroom. She had skid and fallen, heard a sound after the fall
and noticed that her left leg had been deviated. She complained of pain and could
not get up. She had to be lifted and was taken to the hospital. There was no external
injury or bleeding.
➤ She underwent surgery for the same.
➤ She continued to experience pain, and was on bed rest. She could not walk, and
would only get out of the bed with support for going to the bathroom.
➤ 2 months later, she complained of discharge from the surgical wound and sustained
a fall, after which she was told that her X ray showed the screws and plates had
loosened and previous surgery had failed and therefore was operated again.
➤ Following the second surgery, she continued to be on bed rest. She does not move
the left leg, complaining of pain and swelling.
➤ She has been on regular dressing since the surgery.
➤ She is a known case of Diabetes since 20 years and has been on medication.
➤ No history of fever with the onset of discharge
➤ No history of deformity
➤ No history of loss of sensation
➤ No history of any home remedies to the site of fracture.
➤ No History of previous fractures in the past
PAST HISTORY
➤ K/c/o Diabetes. No history of other comorbidities.
➤ H/o past admissions to hospital with uncontrolled blood sugars.
PERSONAL HISTORY
➤ Vegetarian
➤ Normal Apetite
➤ Regular bowel and Bladder movements
➤ No addictions
GENERAL PHYSICAL EXAMINATION
➤ Conscious, Cooperative, well oriented to time place and person. Moderately Built
and Nourished. Was lying supine on bed at the Time of examination.
➤ VITAL : 97.6F
➤ Pulse : 84 beats per minute, regular rhythm, normal volume and character, no radio
radial and radio femoral delay. All peripheral pulses felt.
➤ BP: 130/80 mmHg, Left arm, supine position.
➤ RR : 16 cycles per minute.
EXAMINATION OF LEGS.
➤ INSPECTION
➤ The right leg appeared normal on inspection
➤ Left Leg : External fixator, pin tract dressing.
➤ Healed surgical scar, around 30cm from the medial aspect of ankle to the upper end
of leg
➤ Skin appears hyper pigmented
➤ Healed, Infected. wounds on skin, with no active discharge
➤ Toe movements normal
➤ Left foot appears edematous
PALPATION
➤ Right leg normal.
➤ Left leg :
➤ No local rise in temperature
➤ Tenderness over mid shaft
➤ Toe movements normal
➤ Sensation intact.
➤ Pulses felt

➤ Measurement : Right Lower limb : 92cm Left lower limb : 92cm

SYSTEMIC EXAMINATION
➤ CVS : S1 S2 heard, no murmurs
➤ RS : Bi lateral Normal Vesicular Breath Sounds
➤ Abdomen : Soft and Non tender
➤ CNS : NO focal neurological deficits
SUMMARY
➤ 74 yrs old lady, known case of diabetes mellitus, with history fracture of both bones
of left leg following a fall, managed by Open reduction and internal fixation. Failure
of implant and wound infection managed by AO external fixation. Presents with
inability to walk, pain and swelling of left leg and discharge from surgical wound.
➤ O/E : healed scar of the previous surgery, tenderness on pupation, wounds on leg,
swelling of left foot.
PROVISIONAL DIAGNOSIS
➤ Left Leg, both bone fracture, with non union, with infection. AO external Fixation.
X RAY
END OF PRESENTATION